Organization
JACY 1
Active
Other names
Anchorage
Organization subpart
No
Provider details
NPI number
Authorized official
LAURA LEE LITKE (EXECUTIVE ASSISTANT)
(320) 255-9530
Entity
Organization
Contact information
Practice address
600 25TH AVE S STE 105, SAINT CLOUD, MN 56301-4820
(320) 255-9530
Mailing address
600 25TH AVE S STE 105, SAINT CLOUD, MN 56301-4820
(320) 255-9530
Taxonomy
Speciality
Code
Description
License number
State
324500000X
Substance Abuse Rehabilitation Facility
Primary
10447991CDT
MN
Other
Enumeration date
04/30/2008
Last updated
04/30/2008
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